by Olga PierceUPI Health Business CorrespondentWashington (UPI) Sep 13, 2006
Universities -- both in the United States and in developing countries -- can have an important role to play in improving the return on development dollars spent, advocates said this week.

An upswing in donor largesse has meant an avalanche of new aid funds being sent to the world's poorest countries -- especially to combat AIDS and other health problems. Now, donors and governments have an interest in making sure they go for the best uses.

That concern has led to the development of a new field called evidence-based advocacy, in which funding and development decisions are made based on hard data indicating what works and what does not.

And the expertise required to gather that kind of data resides primarily in universities, the world's research institutions.

"Out faculty helps produce the research, the evidence, that is the basis for global efforts," said Ruth Katz, dean of the George Washington University School of Public Health and Health Sciences, at a forum on the role of universities in development.

A recent collaboration between Johns Hopkins University and the global charity World Vision, for example, took advantage of the school's expertise in measuring quality to improve health programs for children under age 5 in a remote province of Mozambique.

University faculty have developed and implemented a method for assessing the quality of care provided in terms of safety and effectiveness, including self- and peer-assessment tools.

In addition, they are training the health staff of the program in interpersonal communication and counseling skills.

Also, perhaps most importantly, they are teaching the Mozambicans to advocate for improved quality of services in the future, so that gains will be made even after the program ends.

The university is really helping to "research and document the lessons learned and successes of the program," said Dennis Cherian of the African Grants and Management Team at World Vision. That kind of specialization is helpful because often, relief organizations are "a jack of all trades and a master of none."

There are, however, many barriers still in place to university involvement.

"Universities often see these partnerships as consultancies," Cherian said, "so it's really expensive. The overhead costs are really high."

For universities themselves, GWU's Katz said, there is also the appearance of non-objectivity in research. "If we tip our hand one way of another, we may very well lose our credibility."

But that is not the only purpose universities can serve.

The explosion in funding has also led to concerns that governments in Africa and elsewhere will lose the power to set development priorities.

"We must work with them, and not just for them," said Maryam Babangida, former first lady of Nigeria, who currently operates an organization called the Better Life Programme for African Women. Outside goals should not just be "passed on to African communities to address," she said.

In light of the need for African input, professors at U.S. universities can use their networks of contacts with colleagues at African universities to bring them into the global conversation, said Victor Barbiero, a visiting professor of global health at GWU.

In a broader sense, however, U.S. universities, non-governmental organizations and private-sector businesses can speed development in Third World countries by investing in universities there, said Elizabeth Ashbourne, senior operations officer at the World Bank.

"The private sector has a key role, and universities have a key role in connecting with it," she said.

One example of this, she said, is a program operated by pharmaceutical giant Pfizer to train healthcare workers in Rwanda. The program benefits the company, which needs trained healthcare workers, but also the university and, ultimately, the country itself, Ashbourne said.

Universities in developing countries can "define the health agenda, and define the answer to the health agenda," said Victor Barnes, director of the Corporate Council on Africa's HIV/AIDS initiative. "There's a real need to determine what internal resources are, and find a way to enhance those resources."

When it comes to health, Africa's human resources are in dire need of enhancement, according to Doyin Oluwole, director of Africa's Health 2010. "The health sector in Africa has a history of accidental managers and leaders. The people charged to lead healthcare are not always well-prepared for the task."

And now these leaders, prepared or not, are faced with the challenge of managing enormous sums of money, she said. "The challenge we face in Africa is this: who is there to decide how these megafunds that arrive in the coffers of government will be absorbed efficiently?"

The government of Malawi, for example, now faces the threat of losing tens of millions in donor aid because it simply has not been able to spend it all.

U.S. universities and non-governmental organizations can help solve the problem by helping African universities establish training programs not only in health, but the management and leadership skills needed to work in higher-level administration, she said.

Although the opportunities to bring universities into the loop abound, they still remain somewhat uncommon, the panelists said, and this may be because groups are still learning how to establish such cooperation.

One of the reasons such partnerships do not happen more often is that a nudge is needed to encourage these partnerships to take place, the World Bank's Ashbourne told United Press International. "One of the issues is certainly trust, but how-to is also a major barrier. Often it takes a third person or outside party to come in."

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